Dear Dr. Donohue: Cushing's Syndrome

Dear Dr. Donohue: Do your readers a favor by telling them about Cushing's syndrome. It took six years before I was given a diagnosis. The delay cost me my job and my fiance.

I gained weight and had stretch marks all over. Doctors told me to lose weight by dieting and exercise. I did both, but continued to gain weight. Then my blood pressure rose.

Finally, a doctor, to whom I owe my life, came up with the correct diagnosis. I had an operation, and my life has changed for the better. -- P.A.

Dear P.A.: Cushing's syndrome is an overproduction of cortisone. People are surprised that they make cortisone. They think of it as a medicine. Our adrenal glands, sitting above the kidneys, turn out this hormone, which is essential to life.

At first, an overproduction of cortisone produces signs and symptoms that are quite subtle and go unrecognized. As time goes by, weight is gained, the face becomes round and red, the arms and legs remain thin, the chest and abdomen expand. The skin thins and is easily injured. Purple stretch marks appear. Menstrual irregularities occur. Women sprout facial hair. Muscles weaken, as do bones (osteoporosis). Blood sugar rises, and so does blood pressure. All of this comes from having too much cortisone.

The trouble can lie in either of two places, the pituitary gland on the underside of the brain, or the adrenal glands (above the kidneys) that make the hormone. The pituitary gland produces a hormone that stimulates adrenal-gland production of cortisone. Tumors of the adrenal gland, independent of the pituitary gland, can rev up their production of cortisone on their own. Most cases come from a small pituitary-gland tumor whose hormone stimulates the adrenal glands.

It's treated by turning off cortisone production. Surgery is the answer to both causes of Cushing's. With the pituitary gland, the approach can be through the nose or roof of the mouth to reach the pituitary gland and destroy the tumor. When the adrenal gland is the cause, surgery is more involved.